An Anarchist and Healthcare

I’m an anarchist. I’m a Christian. I’m a lot of things. I don’t find the need to have an opinion about everything as lots of Americans do. On some issues I’m opinion-less. But some things strike me as odd.

This up-coming election has brought up, once again, universal healthcare. I’m a capitalist and opposed to big government. But I also know “wrong” when I see it.

There’s something seriously wrong with healthcare in this country. I feel, as many do, that the insurance companies are out of control. My capitalist perspective leads to a couple conclusions:

A) Healthcare is out of reach for many Americans if their employer does not offset some of the cost (mine offsets 2/3rds!!!)
B) Few choose their own healthcare provider thus eliminating the free-market ideas that capitalists subscribe to. Employers choose for you.
C) Insurance companies do not actually provide a true service, they merely provide a means to a service.
D) Insurance companies make money by not providing the service they are supposed to provide, thus putting them at odds with themselves.

Picture it like this: Walmart takes your money from you when you leave with goods. If you want dishware you pick it up and on your way out the door they get money, everyone is happy with the transaction. But let’s say you paid Walmart $5 a month so that if you needed dishware you could come pick it up. Walmart, already having your $5 per month, would feel inclined to keep the money but not provide the dishware.

This is what insurance companies do. Then they put so much red tape around the service that nearly anything can be a reason to not provide care. I don’t even know if the insurance companies understand their own policies. An average person can’t comprehend this stuff.

I don’t know if universal healthcare is the solution to this mess but I do know that the insurance companies most certainly are not.

I’d like to see a system where people provide for themselves for small doctor’s visits: Checkups, physicals, dental cleanings but perhaps a universal system for catastrophic care. You get cancer, a car wreck, your spleen hemmorages on a rollar-coaster; we’d take care of you. Perhaps a dollar limit, any medical bills that go over $15,000 per year would be covered but if you run to the doctor for a cold you pay.

This would open up the market and bring prices down while creating a system that discourages abuse.

Comments (19)

Be careful:
A) If your employer offsets costs, that is extra income he isn’t paying you minus tax rebates.
C) Don’t kill the middleman! Stock brokers provide a service. Delivery boys provide a service, and so do insurance companies. They specialize in evaluating and diversifying risks. They do a good job.
D) Insurance companies manage risk. How can we assign a price to risk? It is subjective. Some people are willing to manage more of their own risk through savings (self-insuring), others prefer to have it managed for them by a specialist. Ever hire an accountant to do your taxes? I hire turbotax, same thing.
Walmart’s inclinations are mediated by the competition of Target and K-Mart. If they didn’t keep their contract they would lose your business. They would go out of business. Think harder about the power of competition and how it benefits all of us.
The red tape wrapped around insurance service has a name: government protected privilege, aka monopoly. All criticisms of this aspect of the industry are completely valid. Even entry into the labor force as an agent is limited by licensing requirements which limits competition and raises prices to consumers. My wife is a health insurance agent, and does quite well. The reality of monopolist behavior in the industry is apparent to anyone who knows a little bit about monopolies.
Universal healthcare would further monopolize the industry and eliminate all incentives to serve the customer created by competition. A better solution is to get the state completely OUT of the industry. No regulation, no oversight, no subsidies. Zilch. The hamburger industry works a lot like this. The sandwich that cost $2 ten years ago, still costs close to $2 today.

Thanks for the post somasoul. It’s an important topic. As a medical student, it’s interesting to note that the conversation above lack’s any discussion of the doctor-patient relationship.

At the clinic where I have been working for the past month, 15 minutes is scheduled for each patient visit; 30 minutes if it’s a complete annual physical. It’s like that at clinics everywhere. Doctors do not have enough time with their patients to really deal with many of their medical problems, arguably because of how reimbursement from the insurance industry is set up. If physicians don’t see enough patients in a given time period, they don’t get reimbursed sufficiently. Don’t get me wrong, I don’t know any starving doctors (and they’re not off the hook!), but I also don’t know any starving insurance company executives. The people who seem to be really losing here are the patients, many of whom have chronic medical problems that require a lot of time, energy, medications, and equipment to adequately manage (e.g. Type 2 Diabetes).

Many of these patients are poor and could not afford to “provide for themselves” for their routine visits to make sure their diabetes and hypertension are under control, let alone pay for the medications they need each month. While it may make sense for young healthy individuals, perhaps like you and me, somasoul, to only have catastrophic health insurance, this does not really make sense on a national level when you consider that our population is not all young and healthy.

Jurisnaturalist (Nathanael), I’m a bit troubled by some of your analogies. While I understand that insurance companies “manage risk” and help people access expensive health care, I do not agree that this is the same idea as hiring an accountant or TurboTax, and it certainly is not akin to the work of delivery boys. In both of those examples the customer is directly receiving a benefit that they are paying for – paying to have taxes filed, or paying to have pizza delivered (or letters, parcels or whatever). Insurance companies in general do not actually provide health care, doctors, nurses, and other health professionals do that.

Although I think it’s reasonable to question whether a single payer system would not have flaws because of the lack of competition, I think it’s important to remember, that health care has become bigbusiness, which might not always be in the patients’ best interests. I disagree with and am disturbed by your assertion that it would be better if there was no regulation and no oversight. Perhaps I’m misunderstanding you, but to me that would spell huge problems for people who need access to care. Can you explain how this would make things better?

I’m not sure I buy the hamburger analogy either (Couldn’t you have at least picked a healthier example?? :). I think there are bigger reasons for the stability of hamburger prices, and I’m not sure it’s safe to say the government hasn’t been involved.

jdaniel,
Thanks for the criticisms.
I don’t think it is the state’s job to help anyone. They are to prevent harm, to protect rights, and to enforce contracts. But not help the needy. That is the unique and exclusive responsibility of the church.
Is a direct benefit better than an indirect benefit? Necessarily?
I am against regulation and oversight because I am against the existence of a pagan institution holding the authority to oversee or regulate, and I see no reason to believe why such a regulatory institution would have incentives more correctly aligned with consumers than insurers Insurance companies face more immediate feedback from consumers than regulatory agencies do, and have incentives to lower costs and make processes more efficient, while regulatory agencies have incentive for spending and expanding their budgets.
Unfortunately, Bono is wrong, because only a very small percentage of the poor remain poor for a significant length of time in relatively free economies. Everywhere we find poverty we will also find privileged individuals protecting their privilege.
Oh, and hamburgers aren’t that unhealthy when consumed in moderation.
Nathanael Snow

Not directly addressing your main question on health care, I’d like to hear you talk about how you see yourself as both an anarchist and a capitalist. In my opinion, the two ideologies are irreconcilable in practice.

Also, about your premises: under the system you suggest, someone pays if they “run to the doctor because of a cold”, because this is abuse. I’d like to hear more about how health care is “abused” – I happen to think there is little evidence to show that people, in fact, abuse health care. Yet, for some reason abuse is already pre-determined to be a reality of the health care system and therefore criteria for the debate on how to reform health care. Or, if going to the doctor when you are sick is abuse, then I question whether or not this is an accurate definition of abuse.

Moreover, I’d like to hear you speak about “government handouts”, what exactly you are referring to. Do you mean “handouts” that are given to low-income people for health care so their kids can go to the dentist? or the kind of handouts government gives to corporations (such as Wal-Mart) in the form of tax credits so they will build more Wal-Marts and bring low-end jobs with unsustainable wages, no benefits, and limited professional development opportunities to our communities?

I tend to agree that government doesn’t do much well (if anything!). And I really, really fear giving them total control over any thing. Once government does that they rarely give it back.

On the other hand, the insurance companies are out of their minds.

Says jdaniel”
“As a medical student, it’s interesting to note that the conversation above lack’s any discussion of the doctor-patient relationship.”

I wasn’t trying to delve into that. I was just sort of contemplating how government would operate it.

I’m sure doctors as a whole have mixed feelings. On the one hand they could treat anyone and get paid. On the other they would be forced to treat anyone and everyone. Doctors would gain some freedoms at the expense of others.

It seems hard to see medical care as a business. We are talking lives here, not shoes or hats or Pop-Tarts. But behind that industry are people working to develop drugs and technology that is better. And those people deserve a return on their investment.

Unfortunately, Bono is wrong, because only a very small percentage of the poor remain poor for a significant length of time in relatively free economies. Everywhere we find poverty we will also find privileged individuals protecting their privilege.

I’m not sure I buy the first part your comment. Could you please provide an example of a “relatively free” economy with a “very small” poverty rate? Could you also elaborate on what you mean by “relatively free?”

I didn’t want to start a post about anarchy and won’t do so. If you’re smart enough to know about anarchy then you’re smart enough to know about anarcho-capitalism. I can’t help but think you’re trolling for an argument. I will however answer some of your questions.

“Also, about your premises: under the system you suggest, someone pays if they “run to the doctor because of a cold”, because this is abuse.”

There are plenty of people who tie up the medical system. If seeing a doctor because you have had a cold for one day is your answer then that is abuse if you don’t pay a dime. I have a cousin who is a hpyocondriac (sp) and runs to the doctor constantly. If you skateboard and break your leg don’t expect me to pay. I want to eliminate as much “at fault” patient visits from the taxpayer purse.

“Moreover, I’d like to hear you speak about “government handouts”, what exactly you are referring to.”

Anytime the government gives money to a citizen or an organization it is a handout. The question becomes “what is justified”? (if anything can be justified).

“or the kind of handouts government gives to corporations (such as Wal-Mart) in the form of tax credits so they will build more Wal-Marts and bring low-end jobs with unsustainable wages, no benefits, and limited professional development opportunities to our communities?”

In Maryland Walmart was going to construct a regional distribution center. People were LINED UP waiting for jobs in an area where jobs are not plentiful. The grocery stores and unions quickly pleaded with the paid-for lawmakers, introducing a bill that would require any employer with more than “X” number of employees in the state to provide full health benefits. The ONLY employer in the ENTIRE STATE WITH THE NUMBER OF EMPLOYEES UNDER THE BILL WAS WALMART. Walmart scrapped plans for the regional distribution center in Maryland leaving many people to, once again, struggle in a slumping job market on Maryland’s eastern shore.

Sam Walton and his company are not faultless. But they do provide cheap and inexpensive drugs, inexpensive clinics, jobs for seniors who often have a hard time finding jobs, health benefits for part-time employees, and advancement in their ranks. It’s not great work but it’s often better than other options that these people have.

It’s easy being a critic, sometimes rightfully so. It’s harder to run a business that can both make money and provide benefits to the uneducated and often unhirable.

When I worked for a local business I got paid less than Walmart employees, had no access to healthcare (FOR PART-TIME EMPLOYEES TOO!!! WHO ELSE OFFERS THAT?!?!), 401k (4% MATCH AT WALMART!!!!), PROFIT-SHARING (A GREAT BENEFIT!!!!), 10% discounts for cell phones, cars, all sorts of stuff!!!

I’m not a Wal-Mart horn tooter but this company doesn’t get a fair shake.

With that said, how many people did you employ today? How many millions of dollars have you provided in healthcare this year?

“Finally, I’d like for you to quote some kind of research on health care……..”

Well, I pay nearly $150 per month for health insurance, my employer pays 2/3. So that’s $450 per month in health benefits for my wife and I that I never use. Nearly $6,000 per year. I don’t need that kind of coverage and I’m sure if the free market was open I could access a doctor as needed for much less than $6k per year.

Maybe I’m wrong. I didn’t do research because I’m lazy. I know the system we have doesn’t work well. That’s my opinion and I’m sticking to it until something better comes along. :)

First of all, I resent the claim that I am trolling for an argument. I have been a serious, long-time contributor to this blog.

Instead, I was trying to deconstruct some of the assumptions behind the argument you were making.

I am quite familiar with anarcho-capitalism and think it’s got about as much merit as “compassionate conservatism” and is generally advocated for by the same group of folks – privileged white kids. I asked you to define your terms; if you don’t want to that’s fine; if you do, start a new post. I’m just generating discussion!

I am an advocate for those living in poverty (it’s my job). I can’t tell you how many times I’ve heard the “I know a guy” or “I have a cousin” or “I met this trucker who…” which is followed by some marginal “abuse” of some system for low-income families which then validates an argument for entirely breaking down and marginalizing an entire population based on classist assumptions.

Therefore, I care little that your cousin is a hypochondriac; and if the system were working properly, s/he would be referred to mental health counseling to properly address the condition. Your anecdotal argument for abuse carries little merit.

Telling me that you worked at a job that pays less than Wal-Mart only tells me that you worked at a crappy job, not that Wal-Mart is a quality employer.

You and your wife don’t use your health insurance coverage but it costs $6,000/ year. I’m not arguing that that isn’t a lot of money (it’s absurd actually), but you should feel privileged to be well. Many folks need to access medical services, some folks have chronic care needs, and often times are cut off from that care or denied care. Opening the free market I highly doubt will fix this, since a free, open market in every other sector has led to monopoly and higher costs. Health care is a universal need, and cannot be pray to the “cost-effective” mentality of private business. It has already led to a slew of problems. No government interference is causing the massive amount of denials for acute care that are happening around the country – as Michael Corleone would say: “it’s strictly business”.

Fringe benefits at Wal-Mart such as profit sharing, and 10% discounts are not a good substitute for self-sufficient wages, which Wal-Mart simply doesn’t pay. Moreover, you’ve overlooked the massive tax relief given to Wal-Mart to build in towns to generate jobs (http://www.wakeupwalmart.com/facts/#taxpayers); the least they could do to thank taxpayers for carrying that burden is to pay a living wage.

The rhetorical argument you make that I have not provided jobs or insured anyone is simply absurd so I’m not addressing it.

If you didn’t do research because you are lazy, then don’t expect me to take your argument at face value or to respect it as a meaningful part of the debate on health care.

Bono’s not wrong. Although in that song (“Crumbs Under the Table”) he was specifically speaking of developing countries, the quote could just as well have been talking about the U.S.

I work among homeless folks. About one tenth of all people in the US are under the poverty line. And about one tenth of those folks will spend time on the street each year. Many of them spend all of there time there. And of those who are on the street, 55% have no kind of health insurance, as opposed to 15% of the rest of the population. I have personally seen two people die because they were given serious hospital care and then released to go back and live on the street or in a shelter.

“Free” economies have their scapegoats. The way of the world is that if someone is to have success and health then someone else must do without.

But when people are treated as less than human because of the economic disparity, is that not poverty?

Amartya Sen, a Nobel-prize winning economist, said, “Poverty is primarily sociological, not economic.” In other words, when people outcast you because of your economic lack, that is what poverty is.

There are more ways to die than simply starvation.

A homeless man I was aquainted with was constantly being stopped by the police and harrased. He hated these stops to such a degree that he often reponded dramatically to them and so the stops increased. Finally, he made a general announcment, “The next time the police harass me, I will kill myself.” Which is exactly what he did.

But the story doesn’t end there. A few folks on the street knew that his body was in his old camp, but were afraid to contact the police, so they let the body stay. Soon a couple of housed men heard about the body, so they found the camp and pulled the old man’s teeth so they could sell the fillings. They were so pleased with this that they filmed themselves abusing this man’s body, and showed it to everyone who came over to their house.

Finally a homeless man couldn’t stand the disrespect the old man was receiving and so he came to me, knowing that I would have no fear of calling the police. By the time I found the body and called 911 about it, the man had been in his camp for six months, through the summer heat and his arm looked like an overripe banana and the flesh of his face had been chewed off by animals.

There is more than one way to be poor.

Isn’t it poor to have a hospital reject you for treatment because they suspect (without proof) that you are a drug addict or an alcoholic?

Isn’t it poor to have frostbite on your feet because you won’t be treated for your oxygen deprivation in freezing temperatures?

Isn’t it poor to be stopped by the police every time you are in city limits, no because you do or do not have a house, but simply because you look homeless?

Isn’t it poor to stand for your religious convictions and immediately be taken away from your church and all of your friends for six months while you are committed to a state hospital in a trial with no witnesses, no evidence presented?

Isn’t it poor to have to beg for gas or food, only to be treated that you are a criminal?

This and so much more is what my friends on the street face. I could go on. And probably will somewhere else.

But the point I am making is that this is what the people under the poverty line are in danger of– one paycheck, one firing away of. And this is what the homeless face everyday.

So, please, don’t tell me that there is no poverty in America or that conditions aren’t that bad. If there was somewhere for my folks to go, they would collect tires to make boats.

I’m curious about several comments people have made regarding people being refused care in hospitals, or about people having been discharged from hospitals and dying (posts 12, 10, and 8).
The truth is that the US already has a form (a poor form, but a form nonetheless) of universal healthcare. EMTALA (http://en.wikipedia.org/wiki/EMTALA), put into effect in 1986, requires that hospitals do several things. Among its requirements is that anyone who presents to an ED be seen and evaluated by a doctor. In the ED I’ve spent some time in (I’m an ICU nurse), triage was done before any questions were asked regarding peoples’ abilities to pay. Once seen, hospitals are required to stabilize patients before doing anything with them (discharge, transfer, etc). There are more particulars about the law, but this is one of its tenets. This doesn’t mean that everyone gets good or even appropriate healthcare. But I am interested in hearing how this attempt to prevent patient dumping in all its nefarious forms is circumvented.
On a broader level, I am curious if anyone has any ideas about how a YAR might act Christ-like in the face of healthcare’s staggering inequities and problems.
Thanks.
jls

I was in a really bad part of Baltimore yesterday. I stopped by this church I have loose ties with to see an old friend. I met the pastor, Pastor Marshall, and they really try to do good stuff. Despite a lack of funds they still provide meals three days a week to the poor. And despite the neighborhood they manage to leave the doors open most of the time. (A guy was shot earlier this year and bled all over the church van. 7 people have been shot in their neighborhood in Feburary……..)

But Pastor Marshall does not have health insurance despite his church’s belonging to the largest penecostal denomination in the world.

How can good people doing these nearly impossible tasks be left out in the cold?

US Treasury data on Income Mobility available at http://www.treas.gov/press/releases/reports/incomemobilitystudyfinal.pdf
look at the second page for these statistics:
“Half of the taxpayers who began in the bottom quintile moved up to a higher quintile in the next decade.
Only 25% of those in the top 1/100 of 1% (the richest of the rich) were still there a decade later.
Median income of all taxpayers increased by 24% after adjusting for inflation.”
How is this possible?
First, young people start out in the low income category and slowly move up to the top earning category by their 50’s, then in their 60’s they drop out of the top income earning category.

People’s lives change, and so do their fortunes.

Now, our concern should be with the helplessly poor. The real least of these. The ones who are stuck. But state programs cannot make this discernment. The list of necessary rules to make the programs only reach the needy would make the management of such programs prohibitively expensive in monitoring costs. Instead they offer less to more. Which encourages mediocrity and discourages mobility for those who might be able to accomplish it.

The same is true even for nations. Ivory Coast used to be wealthy, but bad government has ruined it. Lebanon used to be the jewel of the Middle East, almost rose again, but is caught up in political turmoil.

I like Bono. I like U2. But he is wrong because he advocates the use of state programs to accomplish what is the exclusive role of the church.
Nathanael Snowndsnow@gmail.com

I agree, Nate. I think that as Americans, we are so wealthy we don’t even clean our gutters any more. We want other people to do the churches job. When we do that we squander opportunities for missions and the salvation of souls.

I agree that in this fallen world the government doesn’t take care of the poor very well. Okay, abominably. And actually, historically, the U.S. does better than most nation (although not as well as many nations in Europe where homelessness is almost unheard of).

But I don’t think that it is the church’s “job” to help the poor and the government’s “job” to get out of our way. It is the church’s job to help the poor, judge its own people according to the laws of Christ, establish servant leadership and defend itself by using spiritual warfare. In other words, the church is supposed to REPLACE the government completely when Jesus returns, and the church is supposed to show its worth by doing its job better than any current government.

Unfortunately, the church since Constantine has gotten lazy, allowing the government and corporations to do what it used to do better than anyone– justice.

And part of the problem is division. If we weren’t so set to stay in our denominational groups– Mennonites, Methodists, Baptists, Catholics– even when we completely agree on our goals, perhaps we could get something accomplished. But as long as we use our economic means to create baby administrations for each and every group, we will never have the means to truly make a difference for the poor.

“People in third world countries build boats out of tires to become this nation’s poor. No one starves to death in America”

I find it unlikely that you would say this to person of minimal income or means to such, in America. The internet is a bad judge of tone of voice, but it comes off as very smug, cruel and heartless.

Said in another conversation, in another context I might agree with you. In a way, America is the suburbs of the world. If this was something that you find true, and that there are no truly poor people in america, the question I would then ask you, is why are you living in the suburbs? Or perhaps the suburbs of the suburbs (what is that, the lake house?) In this conversation however…

I live in Afghanistan and it is true that if it weren’t landlocked and so far away people would be building boats to come to America. Some of them do undertake the insane and dangerous journey by land and sea to England, (for an excellent filmisized version of this, see Michael Winterbottom’s “In this World”), most of them to the not much better but easier locations of Pakistan and Iran.

Yes, if we want to quantify human suffering people in america may suffer from discrimination, mild malnutrition, alienation, low income, joblessness, homelessnes, violence, spiritual death, and any number of other things, but people in Afghanistan have most of those things, plus more! So they are more poor! So all people that are not as poor as them should shut up! But wait! What about the people of malawi? they are more poor than those whiny babies in Afghanistan. Afghans aren’t poor! People from malawi can’t even afford boats to go to Afghanistan! And there is barely any AIDS in Afghanistan. No one is poor in Afghanistan!

The point is there is suffering, poverty, violence, and war in every country, city, town, etc, in this world. There is very little true peace, which has nothing to do with living standards, or economic indexes in any part of the world. Some people may be poorer than others, some people may be suffering more than others. But we shouldn’t trivialize the suffering and poverty of Americans just because they aren’t as poor as Afghans. Deep poverty and human suffering exist and are felt everyday by millions of Americans (not to mention those that are american only by force, i.e. indigenous people.)

There is a big place for remembering americas position in the world, and if that was your intent than I understand where you are coming from. But I feel this must be done more carefully, perhaps more humbly, especially if we are not among those poor ourselves, or even if we are, but by choice.

““People in third world countries build boats out of tires to become this nation’s poor. No one starves to death in America”

I find it unlikely that you would say this to person of minimal income or means to such, in America. The internet is a bad judge of tone of voice, but it comes off as very smug, cruel and heartless. ”

I was simply trying to state that the “poor” in America have opportunity available to them. It wasn’t intended to be heartless. The internet can be a confusing place when you inject how you/I want others to sound.

“why are you living in the suburbs?”

I don’t live in the suburbs. I live in Baltimore City, one of the most violent cities in North America.

“The point is there is suffering, poverty, violence, and war in every country, city, town, etc, in this world. There is very little true peace, which has nothing to do with living standards, or economic indexes in any part of the world. Some people may be poorer than others, some people may be suffering more than others. But we shouldn’t trivialize the suffering and poverty of Americans just because they aren’t as poor as Afghans.”

You might be right. And I like the fact that you don’t trivialize things. But people in America at least have the opportunity to get a job. Other areas of the world even a basic thing like work is virtually unavailable. I don’t think comparing one of the richest countries in the world is fair to either Afghanistan or Somalia or any other third world country.

“There is a big place for remembering americas position in the world, and if that was your intent than I understand where you are coming from. But I feel this must be done more carefully, perhaps more humbly, especially if we are not among those poor ourselves, or even if we are, but by choice.”

I think we may be getting bogged down in semantics here. You include racism, spiritual depravity, etc, etc into your definition of “poverty”. I do not. I’m only including economic opportunity.

We agree that America can be “poor” according to your definition but I think we’d both agree America is not very “poor” according to mine.